summary: Researchers are investigating REM sleep behavior disorder (RBD), a condition in which people physically act out their dreams. This parasomnia is more than a nighttime danger. Studies have shown a strong link between RBD and neurodegenerative diseases like Parkinson’s disease.
The multicenter study, called the NAPS Consortium, aims to collect extensive data on RBD and provide a basis for future clinical trials of neuroprotective treatments. No intervention can change the trajectory yet, but researchers hope to develop bioelectronic devices for early diagnosis and treatment.
- Mayo Clinic researchers found that 50% to 80% of people with RBD develop neurodegenerative diseases, especially Parkinson’s-like synucleinopathies.
- The Mayo Clinic team is leading the NAPS consortium, which aims to collect extensive data on RBD from nine different centers in North America.
- Therapies such as bioelectronics and transcranial magnetic stimulation are being investigated as potential future treatments for synucleinopathies.
sauce: mayo clinic
Early one morning, while examining a sleeping patient at the Sleep Medicine Center, Dr. Eric St. Louis noticed something strange.
The patient, a woman in her early 60s, started running under her bedsheets. As her eyelids fluttered, her legs geared up, slow at first, then rapidly she picked up her pace, following a path only she could see. After sprinting for about 30 seconds, she suddenly stopped and opened her eyes.
It wasn’t what Dr. St. Louis expected people with sleep apnea to do.
Later, when I saw her at the office, I asked her what had happened. “Well, sometimes I have strange dreams,” she replied.
“I had a dream that two men were chasing me. I saw a getaway car that was trying to get me away. I finally woke up when I was about to jump in the car.”
Dr. St. Louis, a Mayo Clinic neurologist and sleep medicine physician, has heard countless different versions of the same story. Acting out dreams during sleep is a major symptom of REM (rapid eye movement) sleep behavior disorder or RBD, a parasomnia he and his Mayo Clinic colleagues have treated for decades.
They found that RBD can be an early sign of neurodegenerative diseases like Parkinson’s disease, in addition to potentially harming patients and their bed partners.
Although RBD is thought to affect only about 1% of the general population, it is so prevalent that Dr. St. Louis sometimes identifies it when evaluating patients for another, more common sleep condition. Masu. “It can be quite unexpected and revelation for the patient and for me,” he says.
A team of sleep researchers at the Mayo Clinic is leading an ambitious effort to collect as much data as possible about RBD.
“The ultimate goal is to fully understand the natural history of this disorder so that we can conduct neuroprotective therapeutic trials with medications and interventions that can prevent future development of Parkinson’s disease and dementia,” said Dr. St. Louis. says.
In REM sleep behavior disorder, the brain repeats REM sleep many times during the night, with each cycle getting longer and longer, adding up to about a quarter of the night’s sleep by morning. During REM sleep, the eyes move rapidly under the eyelids, dreams become more vivid and intense, and most of the muscles are paralyzed.
“In an evolutionary sense, that paralysis is a good thing. Otherwise, every time I dreamed of being chased by a tiger, I would jump out of bed and run down the hallway, which is definitely not healthy.” No,” says Michael Silver, M.D., MB, Ch.B., a Mayo neurologist and sleep medicine physician.
However, patients with REM sleep behavior disorder seem to act out their dreams because they have lost that paralysis.
As a result, they can spend the night singing, screaming, screaming, punching, jumping, kicking, and waving their arms, injuring themselves and others, sometimes seriously. One patient jumped across the room to catch an imaginary soccer ball and hit his head on the dresser.
Another pulled out a gun and fired into the hallway at the absent assailant. One mistook his wife for a bear and began strangling her. Another man stood on a mattress, pantomime skied, jumped over a game of moguls, and sprained his ankle when he hit the floor.
Such bizarre dream fulfillment episodes were not recognized as medical conditions until 1986. Over a decade later, Dr. Silver was recognized as a medical condition along with neurologist Bradley Beauve, M.D., and neuropsychologist Tanis Fellman, M.D. Researchers at the University of Mayo have released a series of studies showing that RBD may be more than just a nighttime nuisance.
The researchers found that about 50-80% of people with RBD develop a neurodegenerative disease, specifically a disease in which abnormal deposits of a protein called alpha-synuclein accumulate in the brain. These diseases, known as synucleinopathies, include Parkinson’s disease, dementia with Lewy bodies, and multiple system atrophy.
Toxic masses of alpha-synuclein are thought to damage parts of the brainstem responsible for anchoring muscles during sleep before moving to other areas that control more obvious daytime activities.
“Our research shows that RBD develops years, even decades, before the onset of parkinsonism and cognitive impairment,” says Dr. Ferman. “RBD provides a window of potential for early detection of synucleinopathies and future therapies that specifically target proteins responsible for neurodegeneration.”
chart the disease
Mayo Clinic researchers are helping lead the NAPS consortium, research that will lay the foundation for clinical trials of future preventive treatments.
This study enrolled patients with RBD at nine different centers in North America and subjected them to a battery of tests, including brain imaging, muscle activity, blood tests, genetic screening, neuropsychological evaluation, polysomnography or sleep studies. ing.
“We just have to cast a wide net before we know which tests are the best predictors of the future,” said NAPS co-principal investigator Dr. Beauve.
The researchers plan to follow more than 300 patients over time to map different aspects of their condition, as some develop more obvious neurodegenerative diseases. With that data, we are ready to identify patients at immediate risk and assess the impact of different treatments currently being developed by pharmaceutical companies.
Researchers now have at their disposal several new biomarkers that will allow them to track the condition in greater detail. They can detect and measure α-synuclein in cerebrospinal fluid by spinal tap and small nerve fibers by skin biopsy. And they recently received a grant from the American Brain Foundation to develop blood-based biomarkers for similar purposes.
“I always liken this to high cholesterol,” says Dr. Beauvais. “We now have all the drugs that lower cholesterol and reduce the risk of heart attacks and strokes. Is not it?”
Unfortunately, researchers have yet to discover an intervention that can completely change the trajectory of patients destined to develop Parkinson’s or similar neurodegenerative diseases. This is an ethical conundrum, explains Dr. Silver. “Should we tell patients what will happen in the future when nothing can be done to prevent it?” he says.
Recently, Mayo Clinic researchers surveyed 113 people with RBD to find out what they thought. Over 90% of respondents said they wanted to know they were in danger.
Patients felt that such prognostic information was important to discuss with family and friends and helped them plan for the future. But when researchers asked how the knowledge made them feel, a high percentage of patients said it caused distress or anxiety.
“We have to deal with that anxiety,” says Dr. Silver.
“I spend a lot of time counseling my patients and telling them not to let this control their lives.”
It can take years or even decades for neurodegenerative disease to develop, and not all patients with RBD develop neurodegenerative disease during their lifetime. He also notes that patients can participate in clinical studies if they know they are at risk, an option that may not have been available in the dark.
In the future, the Mayo researchers hope to develop more options they can offer patients to prevent the progression of neurodegeneration.
One of the areas they are exploring has to do with bioelectronics, a type of medical device that uses electronic signals to treat and diagnose disease. For example, transcranial magnetic stimulation (TMS), a non-invasive brain stimulation treatment that uses magnetic pulses to stimulate nerve cells in the brain, is now the standard treatment for depression.
Mayo Clinic psychiatrist Maria Rapid, M.D. is testing whether TMS can reduce mild cognitive impairment. Dr. Beauve believes a similar approach can be applied to synucleinopathies.
Similarly, Dr. Beauve hopes to have bioelectronic devices that can monitor and diagnose RBD as patients live out their dreams in the comfort of their own homes.
“This is a difficult disease to diagnose, because if you don’t know what you’re looking for, you’ll miss it,” he says.
About this sleep disorder and Parkinson’s research news
author: Eric Saint Louis
sauce: mayo clinic
contact: Eric St. Louis St. Louis – Mayo Clinic
image: Image credited to Neuroscience News